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Adductor Tendinopathy

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Other Names

  • Adductor Tendinosis
  • Adductor Tendinitis
  • Adductor Tendonitis
  • Adductor paratenonitis
  • Adductor enthesopathy




  • Most of the epidemiology focuses on "groin injuries" and does not distinguish etiologies, which can be challenging
  • Injuries in the groin area [1]
    • Occur between 2% and 7% in athletes
    • Are as high as 12%–13% in soccer players
    • There is a male predominance


  • Athletes may have an acute injury or strain that fails to resolve
  • Adductor magnus is most commonly implicated


  • Common in sports that involve repeated kicking, rapid change of direction
    • Leads to repetitive microtrauma
  • Overstretching may precipitate pathology
  • Sudden increase in training type or intensity


Associated Conditions

Risk Factors

  • Sports
    • Soccer
    • Rugby
    • Australian Rules football
    • Hockey
    • American football
    • Horse riding
    • Gymnastics
    • Swimming
  • Musculoskeletal
    • Inadequate abdominal strength
    • Lack of flexibility of posterior chain[2]
    • Leg Length Discrepancy
    • Strength imbalance
    • Lumbar hyperlordosis
    • Sacroiliac, sacrolumbar and hip arthropathy
    • Defects of plantar support
    • Marked asymmetry and/or dysmetry of lower limbs
  • Extrinsic risk factors
    • Incorrect training
    • Unsuitable footwear
    • Unfavorable training conditions

Differential Diagnosis

Differential Diagnosis Thigh Pain

Differential Diagnosis Groin Pain

Clinical Features

  • History
    • Patient will complain of medial thigh or groin pain
    • There may have been an acute injury previously, but often insidious in nature
    • They may also endorse hip pain, stiffness
  • Physical Exam
    • Pain with passive abduction
    • There may be pinpoint tenderness, often at the tendinous insertion
    • They may have weak adduction
  • Special Tests


Small calcifications at the pubic symphysis suggesting adductor tendinopathy[3]



  • Findings
    • Edema at the site of injury
    • Often at the attachment of the adductor longus to the body of the pubis
    • If enthesopathy, will show periostitis and adjacent marrow edema


  • Can visualize majority of structures
  • Identify area, extend of injury
  • Serial examinations during recovery phase


  • N/A





  • Indications
    • Failure of conservative measures
  • Technique
    • Adductor open tenotomy
    • Adductor percutaneus tenotomy

Rehab and Return to Play


  • When patient is relatively pain free[4]
    • Begin progressive range of motion
    • Strengthening exercises
  • Acute phase
    • Postural balance techniques through global and site specific stretching
    • Mechanical and proprioceptive orthotic insoles
    • Global postural reeducation (RPG)
  • Subacute phase
    • Muscle strengthening is increased by the introduction of concentric and eccentric exercises
    • Cardiovascular reconditioning in the gym or in a therapeutic swimming pool
    • Core stability

Return to Play

  • Aerobic running with increasing speed
  • Gradually short but intense anaerobic training
  • Stretching and repeated exercises
  • Gradually, exercises with sprints and jumps
  • Athletes begin to practice again with the ball
  • Finally one-on-one tackles and training matches


  • Chronic Pain
  • Inability to return to sport

See Also


  1. Ekstrand J, Hilding J. The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports. 1999:98–103.
  2. Bouvard M, Dorochenko P, Lanusse P, Duraffour H. La pubalgie du sportif, stratégie thérapeutique. J Traumatol Sport. 2004:146–163
  3. Bancroft, Laura W., and Donna G. Blankenbaker. "Imaging of the tendons about the pelvis." American Journal of Roentgenology 195.3 (2010): 605-617.
  4. Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001;29:521–533
Created by:
John Kiel on 11 June 2019 01:50:21
Last edited:
28 September 2021 22:40:32